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Long-Term Daily Triptan Use in 59 Patients
Posted Feb 1999
The following abstract is taken from a research manuscript
for Headache..The Journal of Head and Face Pain by Dr. Robbins and Joseph
F. Maides, Jr., M.S
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Objective
Retrospective evaluation of 59 patients with chronic daily headache who had
been on a daily dose of a triptan medication.
Background
Chronic daily headache is a common problem that often leads to analgesic
overuse. For those patients with moderate or severe chronic daily headache,
daily doses of triptan medications are often utilized in an effort to limit
analgesics.
Methods
Retrospective evaluation was completed on 59 patients with chronic daily
headache who had been on a daily dose of a triptan medication (sumatriptan
(Imitrex) or naratriptan (Amerge)) for a minimum of 6 months. The age of
the patients ranged from 22 to 63; the median age was 48. The mean age for
headache onset was 19. Fifty-five of 59 patients had either chronic tension-type
headache or transformed migraine. Four patients had chronic cluster headache.
Fifty-two of the 55 patients with chronic daily headache experienced migraine
headache as well. These patients had all been refractive to multiple preventive
and abortive medications. They felt that the severity and/or frequency of
the headaches were at least 50% improved on the daily triptan.
Results
Fifty-nine percent of the patients utilized sumatriptan (Imitrex) alone.
Twenty-nine of these 35 patients utilized sumatriptan (Imitrex) tablets alone,
with the majority (72%) being on 50 mg. per day. Twenty patients utilized
sumatriptan (Imitrex) alternating with naratriptan (Amerge), or naratriptan
(Amerge) alone. Tolerance was noted in 25% of patients. Four of these patients
had increased the dose; three other patients changed from sumatriptan (Imitrex)
to naratriptan (Amerge). Thirty-nine percent of the patients had been on
triptans for six to twelve months, whereas 61% had utilized the triptans
for more than one year. Twenty-two percent were on daily triptans for at
least three years. All patients (except one) had been on three or more preventive
medications; the most commonly utilized of these were antidepressants,
beta-blockers, sodium valproate (Depakote), calcium channel blockers, and
NSAIDs. Sixty-nine percent of the patients were concurrently on preventive
medications with the daily triptans. Seventy-six percent of the patients
used abortive medications in addition to the daily triptans; however, analgesic
overuse was no longer seen in these patients. Previous overuse of abortive
medications was identified in 66% of patients.
Side effects were minimal in this patient population. Seven reported fatigue,
3 patients experienced paresthesias, 3 reported mild chest or throat pressure,
and there were no cases of new cardiac symptoms during the course of treatment.
However, this patient population had self-selected the use of daily triptans.
The patients who had reported significant side effects did not continue on
the medications for six months. Routine blood tests were normal in 47 of
59 patients. Of the twelve abnormal blood test results, none were felt to
be due to the triptans. ECG (electrocardiogram) was done in 23 of 59 patients.
Nineteen were normal; the four abnormal results were not felt to be related
to the triptans. Echocardiography was done on five patients; all were normal.
Rebound to triptans was not encountered in this study. The patients who had
demonstrated sensitivity to rebound had discontinued daily triptan use prior
to six months. The most commonly seen associated medical problems were irritable
bowel syndrome, ulcer, gastritis, hypertension, asthma, and arthritis.
Sixty-eight percent of patients were diagnosed as having an anxiety disorder
(usually mild). Fifty-four percent had chronic depression and 47% were diagnosed
as having insomnia.
Conclusions
For many chronic daily headache sufferers, preventive medications have not
been effective. The use of daily triptans offers a small number of these
patients a greatly enhanced quality of life. While triptans have generally
been safe medications, long-term safety with daily use will need to be
investigated further.
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